Adjustments & Transfers
True! Limits are on adjustments, not transfers!
True or False: You can only use the "Collections - Addendum - Claim Status" Billing Note subject on the same day as you enter a "Collections - Claim Status" Note.
True!
True or False: Non-covered denials should be transferred to patient responsibility.
False! Non-covered denials are never transferred to PR. They should be worked to resolution. Only cost share is transferred to PR.
No, the remark code doesn't post to CPR+. Look up the EOB for additional information about denial.
Office Refill Notes - These are the records we obtain from the pain management physician.
What do you key first? Adjustments or Transfers!
Transfers!
True or False: You can alter a billing note template?
False
True or False: Claims billed less than 30 days ago can be worked.
False! Claims shouldn't be worked until 30 days has passed unless given direction from MGMT. If so, include the communication from MGMT in your note.
Claims are billed from here.
CPR+
Home Connect Patients - What record is specific to Home Connect Patients and replaces the ORN/TPOC?
485
What can you use to help calculate the correct adjustment?
Post Transactions in CPR+ and/or the Adjustment Form
True or False: You can leave fields blank in any template that populates.
False: Make sure all fields have information or key N/A.
True or False: When a claim is denied for an unknown reason your first action should be to send an appeal or reconsideration.
False! Research about the claim denial should be done including making a phone call if necessary. Appeals and Reconsiderations should be the last option when working claim denials.
Where can I find the DX code for a claim?
Both! CPR+ it's located in "Edit Claim". Lynx it's located on the TDD, CR or DT.
What do you send with records if the claim is Stock Solutions?
RJ Health Verification and Label
Where can I find the glossary and code details for adjustments?
The tabs located on the adjustment form located in the Forms_Letters folder on the S Drive.
True or False: Always check the "Follow Up Complete?" box.
False! Do not check it when you're sending your Billing Note to someone else or a group. Trick to remember is if your name is in the "follow up assigned to" box, check the box.
True or False: Send an appeal for CO45 - Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
False. This denial code is not a true denial. It is a discount that signifies that the charge submitted is higher than the amount the insurance is contracted to pay.
Where do I go to have something mailed?
Lynx - Document Management Queue. Use this Queue for regular mail, certified mail or requesting a CMS-1500 to be printed.
True or False: When document management gets the records back from the physician, they send them to the insurance company.
False! MRR by default request the ORN and PTEL unless specified we need other documentation. They are attached to the collectors action list. It is then the responsibility of the collector to forward them to the insurance company.
What is the latest date cost share can be transferred?
12 months from the date listed on the final adjudicated EOB. EX: DOS 01/01/2025, claim processed 05/01/2025. You have until 05/01/2026 to transfer PR.
What group do you assign a "Collections - Billing - Credit Rebill - Assignment" billing note to?
Group - Credit Rebill
Where can I find the EOB?
Several possible places. CPR+, Waystar, EOB Deposits folder on S drive, provider portal.
Where do I go to see if Document Management obtained records I requested?
True or False: When we don't have the ORN and PTEL don't send any records now. Submit a request to document management so we can send a complete packet of all records later.
False: Send what records we have (TDD, CR and TD) to keep the claim alive AND request the ORN and PTEL.